Organization
SHARSHAM CORP.
Active
Other names
WILLIS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
FAKHRIDDIN ACHILOV (OWNER)
(347) 270-0881
Entity
Organization
Contact information
Practice address
370 WILLIS AVE, BRONX, NY 10454-2182
(347) 270-0881
(347) 270-0882
Mailing address
370 WILLIS AVE, BRONX, NY 10454-2182
(347) 270-0881
(347) 270-0882
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040014
STATE BOARD
NY
Enumeration date
03/10/2023
Last updated
12/05/2024
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